Regional Ebola and Other Special Pathogens Treatment Center [Insert airborne transmissible special pathogen name] Tabletop Exercise
Contents
Contents iii
Exercise Overview 5
About NETEC 7
Using This Document 8
Preface 9
General Information 11
Background 11
Purpose 11
HPP Measures 11
Scope 13
Target Capabilities 13
Exercise Objectives and Target Capabilities 13
Participant Roles and Responsibilities 15
Exercise Structure 15
Exercise Guidelines 16
Exercise Assumptions and Artificialities 16
Exercise 1: Activation, Transport Coordination and Patient Care for [Stable or Critical] [insert airborne transmissible disease name] Patient 17
Module 1: Unit Activation following Notification of Pending Transfer of [insert airborne transmissible disease name] Patient 18
Module 1B: Air Transport of a Critical Patient from Overseas 20
Module 2: Patient Transport to Regional Ebola and Other Special Pathogen Treatment Center for [Stable or Critical] Patient with [insert airborne transmissible disease name] and Patient Hand-Off 22
Module 3: Care of [Stable or Critical] Patient at the Regional Ebola and Other Special Pathogen Treatment Center with [insert airborne transmissible disease name] 23
Exercise 2: Admit a Walk-In Patient from Regional Ebola and Other Special Pathogen Treatment Center's Emergency Department (ED) 26
Module 1: Identification and Isolation of Patient with Possible [insert airborne transmissible disease name] in the ED 26
Module 2: Regional Ebola and Other Special Pathogen Treatment Center's Activation following ED Arrival of Patient with Possible [insert airborne transmissible disease name]. 27
Exercise 3: Planning for Special Considerations at Regional Ebola and Other Special Pathogen Treatment Center 28
Module 1: Surge Capacity 28
Module 2: Laboratory Support Services 29
Module 3: Diagnostic Radiological Studies 30
Module 4: Pediatric Patient 30
Module 5: Waste Management 31
Module 6: Surgical Intervention 32
Module 7: Decedent Management 32
Module 8: Labor/Delivery 33
Appendix A: Exercise Schedule 35
Appendix B: Invited Exercise Participants 36
Appendix C: Relevant Plans 37
Appendix D: After Action Report/Improvement Plan (AAR/IP) 35
Appendix E: Participant Feedback Form 40
Appendix F: Acronyms and Abbreviations 42
Exercise Overview
Exercise Name / [Insert the formal name of exercise, which should match the name in the document header]Exercise Date / [Month/Day, Year]
Scope / This exercise is a [exercise type], planned for [exercise duration] at [exercise location]. Exercise play is limited to [exercise parameters].
Mission Area(s) / [Prevention, Protection, Mitigation, Response, and/or Recovery]
Target Capabilities / Foundation for Health Care and Medical Readiness, Health Care and Medical Response Coordination, Continuity of Health Care Service Delivery, and Medical Surge. [List any other applicable target capabilities being exercised]
Objectives / 1. Evaluate the Regional Ebola and Other Special Pathogen Treatment Center to coordinate transportation arrangements, and receive a patient with [suspected or confirmed] [insert airborne transmissible disease name] for evaluation, treatment and admission within an appropriate time frame.
2. Exercise the notification and communication processes internally with rostered staff and externally between local, state, and federal public health, EMS, and other healthcare delivery system partners, Assessment Hospitals, ETCs, and the Regional Ebola and Other Special Pathogen Treatment Center, as well as media management.
3. Evaluate EMS capabilities, and determine the most appropriate method for transportation (e.g., air versus ground.)
· Management of [stable or critical] patient or PUI transported by ground EMS personnel
· Evaluate the management of patient undergoing air transportation and coordination with ground EMS personnel for [stable or critical] patient or PUI
4. Evaluate just-in-time PPE don / doff training resources and PPE availability for EMS, and other healthcare delivery system personnel, including the ETC.
5. Assess policies and procedures governing care of patient at the Regional Ebola and Other Special Pathogen Treatment Center
6. Assess planning for special considerations (e.g., surge capacity, laboratory services, diagnostic radiological imaging, pediatric patient, waste management, decedent management, labor/delivery, surgical intervention)
7. [List any additional exercise objectives]
Hazard / Special Pathogen
Scenario / [Insert a brief overview of the exercise scenario, including scenario impacts (2-3 sentences)]
Sponsor(s) / [Insert the name of the sponsor organization, as well as any grant programs being utilized, if applicable]
Participating Organizations / [Agency/Department]
[Agency/Department]
Point of Contact / [Agency/Department]
Name
Title
Phone
[Agency/Department]
Name
Title
Phone
About NETEC
NETEC is a consortium of Emory University, NYC Health + Hospitals, and the University of Nebraska Medical Center, as equal partners, who support ASPR and the CDC by developing the National Ebola Training and Education Center. All three institutions have safely and successfully cared for patients with Ebola virus disease (EVD) since the beginning of the outbreak in March 2014. The goal of the NETEC, over its five-year funding period, is to increase the competency of health care and public health workers and the capability of health care facilities to deliver safe, efficient, and effective Ebola patient care through the nationwide, regional network for Ebola and other infectious diseases. The objectives are: 1) to develop metrics to measure facility and health care worker readiness (including health care worker training) to care for patients infected with the Ebola virus and other special pathogens (e.g. variola or smallpox, Marburg virus, Yersinia pestis, anthrax, or measles); 2) to conduct assessments, monitoring, recognition reporting, and validation of Regional and State Ebola Treatment Centers and Assessment Hospitals; 3) to create and maintain a comprehensive suite of timely and relevant educational materials related to care of patients with Ebola and other special pathogens; 4) to identify and incorporate best practices regarding how health departments and treatment centers collaborate around the care of patients with Ebola virus infection; 5) to establish a web-based repository to support dissemination of timely and relevant materials; 6) to support the public health departments and health care facilities through training and technical assistance.
Exercise Resource Technical Assistance:
NETEC offers 24/7 Exercise Technical Assistance with subject matter experts who are versed in HSEEP exercise design and development. Exercise Technical Assistance can include onsite exercise assistance (e.g., observer, evaluator), and remote technical assistance (e.g., exercise development).
Contact:
NETEC Exercise Resource Activity Director:
Nicholas V. Cagliuso, Sr., PhD, MPH
Assistant Vice President, Emergency Management
NYC Health + Hospitals
NETEC Exercise Resource Task Lead:
Syra S. Madad, DHSc, MSc, MCP
Director, System-wide Special Pathogens Program
NYC Health + Hospitals
NETEC Exercise Resource Reviewers:
Name / Institution / TitleElizabeth L. Beam, PhD, RN / University of Nebraska Medical Center, Nebraska Biocontainment Unit / Project Coordinator and Assistant Professor
Shawn G. Gibbs, PhD, MBA, CIH / Indiana University, School of Public Health-Bloomington / Executive Associate Dean and Professor
Kristine Sanger, BS, MT(ASCP) / University of Nebraska Medical Center, Center for Preparedness Education / Director of Hospital Training and Exercise Programs
Sam Shartar, RN, CEN / Emory University Office of Critical Event Preparedness and Response CEPAR / Senior Administrator
Using This Document
1. As the exercise planner, you are responsible for scheduling the exercise and inviting the appropriate individuals to the exercise. It is best to plan for approximately 30 minutes to 2 hours per module, plus 1+ hours for instructions and hotwash (Appendix A).
2. This template should be customized to meet each end users unique requirements.Insert appropriate selection into highlighted gray areas.
3. You will need to assign someone to facilitate and evaluate the exercise at your site and write the After Action Report and Improvement Plan (Appendix D).
4. To ensure the best possible learning opportunity for your team, it is strongly recommended that you already have a plan in place for the processes that are discussed in this document. The scenarios and injects that comprise this exercise are designed to stimulate thought and discussion about your current plans and how to improve them.
5. On the day of the exercise, your team should gather in a conference or training room to participate in the exercise using a single computer, combination computer/LCD projector and/or handouts.
6. Invite your entire Incident Management Team to this Tabletop exercise. If you do not have an Incident Management Team, some suggestions of people to invite would be:
· Senior Administrative Leadership (e.g., CEO, COO, CMO, CNO or CFO)
· Emergency Preparedness Coordinator
· Physicians
· Nurses
· Nursing Assistants
· Facilities Management staff
· Environmental Services staff
· Infection Prevention Leadership
· Respiratory Protection Program/Industrial Hygiene Leadership
· Any other staff members that participate in patient care
7. Consider inviting members of your local Public Health, Fire and Rescue, Law Enforcement, and/or Emergency Medical Services (EMS) teams.
8. Have all participants fill out a Sign-in Sheet.
9. It is helpful for each participant to have a handout that includes the scenario and questions for the exercise so they can follow along and reference the scenario as questions arise during the discussion. This document should be developed based on the portion of the exercise that is planned.
10. Have all participants fill out a Participant Feedback form and hand back to you. (Appendix E)
11. To ensure this Tabletop Exercise meets the requirements of Joint Commission, you will need to have additional community members (local Public Health, etc.) in the room for your discussion. (FOR JOINT COMMISSION ACCREDITED FACILITIES ONLY)
12. An After Action Report (AAR) template (Appendix D) is included in this packet. This is a template for you to fill out after the exercise is completed. It will allow you to easily organize your strengths, weaknesses and improvement planning efforts.
Preface
There has been much focus and effort toward preparedness for Ebola. Ebola is transmitted through direct contact with infected blood or body fluids. Health care facilities in the United States must also be prepared for diseases that are transmitted through the air such as Middle East Respiratory Syndrome Coronavirus (MERS-CoV), or other highly communicable airborne and non-airborne diseases. By building upon the established regional, tiered approach set forth by Health and Human Services (HHS) for Ebola Virus Disease (EVD), health care facilities can support a system of care for special pathogens including highly communicable airborne and non-airborne diseases, all of which pose a significant burden on the healthcare delivery system and require real time access to expertise in infectious disease management; and involve strategies and tactics related to overall preparedness to special pathogens.
Health care facilities should outline plans from an ‘all hazards’ view for administrative, environmental, and communication measures that will be required to prevent spread, and manage the impact on patients, the facility, and staff for incidences involving special pathogen diseases.
By exercising plausible scenarios of varying type and magnitude, including highly communicable airborne and non-airborne diseases, health care facilities can maintain an appropriate level of readiness to respond effectively to special pathogen diseases. The proposed airborne diseases in Table 1 are not an exhaustive list of highly communicable airborne diseases. Rather, the list is an impetus to serve as a starting point for health care facilities to begin planning for other highly communicable diseases.
NOTE: The purpose of this template is to give end-users an option when designing, conducting, and evaluating special pathogen exercises and to choose a single airborne-transmissible pathogen and expeditiously proceed.This exercise template has been developed by the National Ebola Training and Education Center (NETEC) utilizing the Homeland Security Exercise and Evaluation Program (HSEEP), which provided a “set of guiding principles for exercise programs, as well as a common approach to exercise program management, design and development, conduct, evaluation, and improvement planning.” (http://www.fema.gov/media-library-data/20130726-1914-25045-8890/hseep_apr13_.pdf).
This is a facilitated discussion intended to probe and explore the Regional Ebola and Special Pathogen Treatment Center’s ability to identify and stabilize a patient who may have an airborne transmitted highly infectious disease; to initiate care and implement special protocols that may be required for the protection of the healthcare facility and its staff; and to coordinate such care with other HCC partners, including EMS, Public Health and Emergency Management. Special considerations are given to surge management; laboratory services; waste management; care of a pediatric patient; and decedent management.
The series of questions included in this document are intended to initiate discussion and description of how the Regional Ebola and Special Pathogen Treatment Center would respond to such an event. It is not anticipated that every question will be answered in every session, or that every question is relevant to every Regional Ebola and Special Pathogen Treatment Center setting. Please utilize these questions to explore the many complexities involved in the management of patients with an airborne transmitted highly infectious disease, whether it be done in one session, or divided up over a number of sessions in which specific topics (coordination of EMS transport, implementation of patient care protocols, development of joint messaging, etc.) are discussed in greater detail.
Please note that there are four (4) specific measures (framed as specific questions in the body of this document) that are REQUIRED to be asked and answered by coalitions that received funding through the HPP Ebola Preparedness and Response Activities funding opportunity announcement. Nine (9) OTHER HPP measures are also included to further probe Regional Ebola and Other Special Pathogen Treatment Center's ability to evaluate and stabilize a patient who may have an airborne transmitted highly infectious disease.
General Information
Background
The Hospital Preparedness Program (HPP) Ebola Preparedness and Response Activities funding opportunity announcement (FOA) provided awardees with funds to support a regional, tiered approach to the management of Ebola and disease caused by other special pathogens. At the state or jurisdiction level, awardees include health care facilities that are capable of serving as State-Designated Ebola (and other Special Pathogen) Treatment Centers (ETCs), Assessment Hospitals and Regional Ebola and Other Special Pathogen Treatment Centers. Additionally awardees may support health care coalitions to prepare Frontline Facilities, emergency medical services (EMS), and the overall health care system in special pathogen preparedness activities. Special pathogen health care system preparedness, response, and the development of a regional Ebola and Special Pathogen treatment strategy were supported by ASPR through HPP. HPP has created specific metrics to assess progress in meeting the goals of the HPP Ebola Preparedness and Response Activities (FOA). For the purpose of these exercises, hese metrics have been modified by NETEC and approved by ASPR to also serve Special Pathogen Preparedness and Response.
Hospitals designated as Regional Ebola and Other Special Pathogen Treatment Centers [RESPTC], with the support of their state or jurisdiction HPP awardee, will serve as the hub of the treatment network, which also includes ETCs, Assessment Hospitals, and Frontline health care facilities. This network will be supported through at least 2019 by regular exercises and plans that describe how Ebola and Special Pathogen patients under investigation are identified, assessed, diagnosed, and if necessary, safely transferred to the appropriate facility for definitive treatment.
Purpose
The purpose of the facilitated discussion exercise is to evaluate, review, and measure the regional response elements related to the Regional Ebola and Other Special Pathogen Treatment Centers, in which it must: 1) support regional planning for the development of a regional network for special pathogen patient care, and 2) develop, support and maintain Regional Ebola and Other Special Pathogen Treatment Centers. The results of this exercise may be used to support fulfillment of the RESPTC-related HPP measures.